Devendra, who was a farmer in India, still remembers the moment a snake sunk its fangs into his leg while he was picking mulberry leaves.
“I went to the hospital four days after being bitten, when the pain became unbearable. But the delay cost me my leg,” he says in a short film released by the Global Snakebite Taskforce (GST), an initiative that works to reduce deaths and injuries from snakebites.
But Devendra is still among the lucky few who survived. According to the federal government, about 50,000 Indians are killed by snakebites each year – roughly half of all deaths worldwide. Some estimates suggest the toll could be even higher: between 2000 and 2019, India could have seen as many as 1.2 million deaths, an average of 58,000 a year, a 2020 study said.
Now, a new report from GST has found that 99% of healthcare workers in India face challenges in administering antivenom – the life-saving antibodies that neutralize the toxins in venom. The researchers surveyed 904 medical professionals across India, Brazil, Indonesia and Nigeria, the countries most affected by snakebites, and found similar barriers: poor infrastructure, limited access to antivenom and insufficient training.
Almost half of the professionals reported that delays in treatment had led to serious complications in their patients, including amputations, surgeries or lifelong mobility problems.
In 2017, the World Health Organization (WHO) formally listed envenoming or snake envenomation as a “neglected tropical disease of high priority” due to the high number of deaths caused by it. According to WHO, around 5.4 million people around the world are bitten by snakes every year and more than 100,000 die from it every year.
It also states that snakebites disproportionately affect poor rural communities in low- and middle-income countries.
Devendra’s leg had to be amputated after he was bitten by a snake while collecting mulberry leaves [Strike Out Snakebite]
In India, a high concentration of deaths and injuries with snakebite are reported in the central and eastern regions, says Dr. Yogesh Jain, GST member and practitioner in the central state of Chhattisgarh. He adds that people who work on farms, including those from poor tribal communities, remain the most vulnerable.
In 2024, India launched the National Action Plan for the Prevention and Control of Snakebite Envenoming (NAPSE) with the aim of halving snakebite deaths by 2030. The plan focuses on better surveillance, improved antivenom availability and research, improved medical capacity and public awareness campaigns.
Experts agree that it is a step in the right direction, but implementation has been inconsistent.
“In India, snake bites are considered a poor person’s problem,” says Jain. “That’s why there’s not enough outrage or action on these completely preventable deaths. When it comes to snakebite treatment, every second counts.”
He explains that snake venom enters the bloodstream in a few minutes, attacking nerves, cells, or the circulatory system depending on the species. Delay in administration of antivenom may result in respiratory failure, paralysis, irreversible tissue damage, or organ failure.
However, hospital delays are common in rural India where bad roads, distant hospitals and lack of ambulance services prevent timely treatment.
Last September, a pregnant woman in the state of Gujarat reportedly died on the way to hospital after her family had to carry her in a cloth sling for 5km (3 miles) because no vehicle could reach their village.
Jain says some states are trying to improve access by stocking antivenom in primary and community health centers. But the correct administration remains a great challenge.
Many health workers are not trained professionals and are afraid to give antivenom because patients can sometimes develop adverse reactions.
“The antivenom is mixed with saline and injected intravenously over an hour, but many centers are not equipped to handle the side effects,” says Jain.
Another problem, he adds, is that many people in rural India still rely on faith healing or local medicinal practices and go to hospitals only when their symptoms worsen, which can be lethal.
Gerry Martin’s The Liana Trust has been researching antidotes for bites from regional snake species [The Liana Trust]
Gerry Martin, co-founder of The Liana Trust, which works to reduce human-snake conflict in the state of Karnataka, says another major obstacle is the availability of high-quality antivenom.
Currently, India has antivenom that only protects against the “big four” snakes – the spectacled cobra, the common krait, Russell’s viper and the saw viper – which are believed to be responsible for the majority of bites. The antivenom is produced by injecting venom from these snakes into horses, whose antibodies are then used as a treatment for humans, explains Martin.
But there are dozens of other species of poisonous snakes for which India does not have a targeted antivenom. These include the green pit viper commonly found in the northern state of Himachal Pradesh, the Malabar pit viper and the hump-nosed pit viper found in the southern states and many other species in the northeastern states.
A study by Aiims (all India Institute of Medical Sciences) in Jodhpur, Rajasthan, last year highlighted the problem. She found that when the antivenom used to treat saw-scaled viper bites was administered to 105 snakebite patients (where the species remained unknown), two-thirds did not respond well to the treatment.
The study concluded that there was an urgent need for a “region-specific antivenom in western India”.
For the past five years, The Liana Trust has been studying poisons from species beyond the big four to develop antidotes for them. But progress has been slow, says Martin, because the process is labor-intensive and time-consuming.
He appealed to the states to imitate the 2024 order by the government of the southern state of Karnataka that made snake bites a “notifiable disease” – making it mandatory for health professionals to report it to the authorities – to combat under-reporting.
Jain agrees. “Snake bite deaths begin where political will ends,” he says.
“Governments should ensure that poor people do not have poor health systems. They deserve better.”
Follow BBC News India on Instagram, YouTube, Twitter and Facebook.